What is
it?Excessive daytime sleepiness (EDS) is a disorder in
which a person feels tired during periods when he wishes
to stay awake. Individuals affected by excessive daytime
sleepiness tend to doze off without warning in various
situations. Examples include falling asleep while in
conversation, reading or watching television, or even
more seriously, while driving. People that experience
excessive daytime sleepiness suffer mostly short-term
effects, such as poor self-esteem due to not being able
to predict when they will get sleepy in certain social
situations, and temporary poor job performance.

What
are the causes?Excessive daytime sleepiness is caused
by not getting enough hours of sleep, or from a lack of
enough quality hours of sleep. The average person needs
eight continuous hours of sleep per day. If an
individual does not stick to a normal sleep routine, he
may be affected by this disorder.

Excessive daytime
sleepiness may be caused by a more severe, underlying
sleep disorder. These sleep disorders prevent a person
from obtaining a quality night’s sleep.

What
are the signs and symptoms?The main sign that an
individual has excessive daytime sleepiness is that he
cannot stay awake in situations when he should — or
wants to — stay awake. People with excessive daytime
sleepiness show a lack of energy during periods of
alertness.

How is
it diagnosed?Excessive daytime sleepiness can be
diagnosed after a routine physical and discussion with a
doctor. Tests can be administered to analyze whether
abnormal hormone levels in the thyroid could be causing
excessive daytime sleepiness.

How is
it treated?Excessive daytime sleepiness, if not caused
by another sleep disorder, is treated by regulating the
sleep cycle. A patient should make sure to get enough
sleep on a daily basis and stick to the same sleep
routine day after day.

If EDS is caused by an underlying
sleep disorder, that disorder will be treated, and EDS
should be eliminated or reduced.

The
Link between Heart Conditions and Sleep Disorders
Experts agree that there is a direct connection among
sleep, sleep apnea and heart disease.

Individuals with
sleep apnea repeatedly stop breathing during sleep and
must partially wake each time to gasp or snort for air.
This is caused by the main breathing passage in the back
of the throat closing or becoming too narrow.

The
result? People who have sleep apnea often develop high
blood pressure and heart disease. For individuals who
already have a heart condition, sleep apnea can worsen
their health.

The Connection between Sleep Disorders and
Heart DiseaseSleep-related breathing disorders can
directly cause certain heart conditions, or can worsen
these conditions if they previously existed.

High blood
pressure: Sleep apnea causes the heart rate and blood
pressure to increase. These nightly increases in blood
pressure eventually lead to permanent increases in blood
pressure, even during the day.

Coronary artery disease:
People with sleep apnea have higher rates of coronary
artery disease (CAD). This is because the apnea
increases the risk for high blood pressure, a main cause
of CAD, and because events that occur during the apnea
can put added stress on the heart and worsen existing
disease.

Heart failure: Many experts believe that about
50 percent of heart failure patients suffer from sleep
apnea. Disorders of sleep and breathing can both cause
heart failure and develop as a result of heart failure.

Stroke: High blood pressure is the most common cause of
stroke, and sleep apnea can lead to high blood pressure.
Also, sleep apnea may cause strokes directly since blood
flow to the brain is reduced and the level of oxygen
drops during apneas.

Arrhythmias: Several studies have
shown that heart failure patients with sleep apnea have
a higher prevalence of atrial fibrillation and
ventricular arrhythmias (irregular heartbeat). People
who have ventricular tachycardia (a rapid heart rate) or
a pacemaker are also more prone to have sleep apnea.

Sleep Diagnostics / Sleep
Specialists specializes in the care of patients with heart
conditions as well as severely overweight individuals.
We diagnose and treat sleep disorders, and provide
therapeutic devices. Our head physician and medical
director for the center, Shahrokh Javaheri, M.D., is
internationally known for his research in sleep
disorders and in the correlation of sleep disordered
breathing to cardiovascular disease.

Our well-trained
and compassionate employees are experienced in the
techniques required to administer sleep studies to
patients with heart disease or heart failure. They are
knowledgeable about the links between sleep apnea and
heart conditions and take this into consideration as
they work with you to achieve success with your
prescribed therapy.

What is
it?Insomnia is a disorder that prevents a person from
falling asleep and/or staying asleep when he desires.
There are two main types of insomnia:

Primary insomnia
is more serious and means that a person is having sleep
problems that are not caused by a health condition or
other problem.

Secondary insomnia means that a person is
having trouble sleeping because of something else, such
as a health condition (like depression, heartburn,
cancer or asthma), pain or medication being taken.

What
are the causes?Insomnia can vary in how long it lasts
and to what extent it affects a person’s lifestyle:

Short-term insomnia (called “acute insomnia”) lasts a
short amount of time, usually from one night to a few
weeks. It usually is caused by emotional or physical
discomfort — brought on by things such as environmental
disturbances (noise, changes in the weather), stress,
medication side effects or jet lag.

Chronic insomnia
lasts a long time — three nights a week for one month or
longer. It can be caused by many things, but is often
caused by underlying medical conditions such as
depression, chronic stress, or pain and discomfort at
night.

Individuals who are female, older than age 60 and
have a history of depression are more prone to have
insomnia.

What are the signs and symptoms?A main sign
of insomnia is not being able to sleep at times when the
body is obviously tired. A person with insomnia will be
tired the next day and may have a lack of energy.

Other
symptoms include waking up earlier than expected and not
being able to fall back asleep when waking up through
the night.

How is it diagnosed?A routine physical and
discussion with a doctor may determine a diagnosis of
insomnia. The doctor may review the patient’s medical
history, discuss any recent lifestyle or environmental
changes with the patient, and ask questions about the
quantity and quality of sleep the person is getting.

Tests conducted at
Sleep Diagnostics / Sleep
Specialists, such as a polysomnogram, can be conducted to diagnose whether the
insomnia is caused by an underlying sleep disorder.

How
is it treated?Short-term insomnia will eventually go
away on its own. There are certain steps a patient can
take in the meantime:

In the case of chronic insomnia, the goal of
treatment is to first treat the underlying medical
condition causing the insomnia.

Treatment may involve:

Medication, such as sleeping pills — dosage should be as
small as possible and be gradually lowered as treatment
continues.

Relaxation techniques — listening to tapes or
doing stretching exercises can help a person relax in
order to fall asleep.

Sleep restriction and
reconditioning — a bed should only be used for sleep. If
a person has trouble falling asleep, he should leave his
bed and return at a time when he is more tired. It may
be detrimental to lie in bed thinking about falling
asleep. It is important not to use the bed for other
activities such as reading and watching television; the
body may condition itself to stay awake, not only during
those activities, but any time the person is in bed.

What is
it?Narcolepsy is a sleep disorder characterized by
excessive and overwhelming daytime sleepiness. Sudden
and uncontrollable, though often brief, attacks of deep
sleep occur when an individual does not want to fall
asleep, such as while working, eating or driving. In
addition, nighttime sleep may be interrupted with
frequent awakenings.

What are the causes?There is
strong evidence that narcolepsy may run in families. It
appears that narcolepsy is a disorder of part of the
nervous system that controls sleep and wakefulness. It
is a disorder in which rapid eye movement (REM) sleep,
or deep sleep, occurs at an abnormal time.

Usually, a
person enters non-rapid eye movement (NREM) sleep when
he first falls asleep. Brain waves during this period
become slower and less regular. A couple hours later, a
person enters REM sleep (deep sleep), which is when
brain waves become more active and dreaming occurs.

In
narcolepsy, REM sleep occurs as soon as a person falls
asleep instead of after NREM sleep. As a result, sleep
paralysis and hallucinations may occur while falling
asleep or waking up.

What are the signs and symptoms?
Symptoms usually appear after adolescence, but may take
longer to diagnose since people with this disorder often
suffer for years before seeing a doctor about their
problem.

An individual with narcolepsy may have one or
more of these symptoms:

Excessive daytime sleepiness —
when a person cannot force himself to stay awake at
times of the day when he wants to be awake. This usually
occurs at the same time each day.

Cataplexy — a sudden
loss of the ability to control muscle movements in the
body. This can be slight, such as dropping of the jaw,
slurred speech, or knee buckling, or severe, such as a
complete collapse of the body. Strenuous activity or
intense emotion such as heavy laughter often triggers
cataplexy. This symptom is unique to narcolepsy and does
not appear in individuals with other sleep disorders.

Sleep paralysis — when a person cannot move or talk for
a short period of time, either right before falling
asleep or directly after waking up. This can last a few
seconds to minutes.

Hallucinations — memorable, scary
dreams that occur right before falling asleep or
directly after waking up.

Automatic behavior — when a
person performs a routine task but is not aware of doing
it, or later has no recollection of performing the
activity. Patients with narcolepsy always have excessive
daytime sleepiness, but the presence of cataplexy, sleep
paralysis or hallucinations is less common.

How is it
diagnosed?There are many types of sleep disorders that
have the same signs and symptoms. Tests can be conducted
at Sleep Diagnostics / Sleep Specialists to determine if a patient has
narcolepsy, including a day and/or overnight polysomnogram (sleep study) and multiple sleep latency
test (MSLT). Test results of a person with narcolepsy
will show that he falls asleep rapidly and enters REM
sleep early.

How is it treated?Medication is the most
common method of treatment. A combination of stimulants
and antidepressants may be used. Stimulants often
improve a person’s ability to stay alert and awake
during the day, while the antidepressants tend to
control the symptoms of cataplexy, sleep paralysis and hypnagogic hallucinations.

It is crucial that
medications prescribed for narcolepsy do not interfere
with other medications a patient might be taking. As
long as the side effects of the medications can be
controlled and the patient is diagnosed early enough,
the disease can be managed.

There are some things an
individual with narcolepsy can do to help cope with the
disease:

●Avoid caffeine and alcohol●Get enough exercise●Follow a proper diet●Establish a regular sleep routine
(which may include regular naps)●Use bed for sleep only

Obesity
is a major risk factor for snoring and sleep apnea.
Excess weight, or fat deposits, in the throat area and
neck can narrow the airway and even periodically
obstruct air passage during sleep. This can cause you to
stop breathing repeatedly for brief periods.

This
medical condition is called sleep apnea and can cause
many negative effects on your health, such as daytime
drowsiness, high blood pressure and cardiovascular
disease.

It is important to note that, while obesity is
a major risk factor for sleep apnea, this sleep disorder
occurs among people of all weights and sizes.

Sleep Loss
and Obesity: A Vicious CycleObese individuals often
find it difficult to sleep normally, usually because
they:

●Have sleep apnea●Suffer from low back pain or
other pain due to the extra weight●Are depressed or
worried about their weight

People who do not get enough
quality sleep may be less physically active, which means
weight gain is more likely. Also, some research suggests
that sleep loss makes a person feel hungry even if he is
full, and it may interfere with the body’s ability to
metabolize carbohydrates, which increases fat storage.

Diagnosis and TreatmentThe good news is that
obesity-related sleep apnea can be treated. Losing
weight can reduce the problem since weight reduction
reduces obstructive breathing episodes during sleep.
Even modest weight loss can help get the condition under
control.

However, there are other medical treatments to
help you if you have sleep apnea, such as nasal
continuous positive airway pressure (CPAP).
Sleep Diagnostics / Sleep
Specialists is experienced in the techniques required to
administer sleep studies to severely overweight patients
in order to diagnose sleep apnea. We are knowledgeable
about medical conditions that often accompany sleep
apnea in these individuals and take this information
into consideration as we develop a treatment plan.

Part of Your Comprehensive ProgramIndividuals involved in a weight loss program or who
undergo weight loss surgery often are referred to
Sleep Diagnostics / Sleep
Specialists as part of a comprehensive plan of
care. We will diagnose and treat your sleep-related
breathing disorder, and, as you lose weight, we will
continue to monitor and adjust your treatment plan.

What is
it?Parasomnias are sleep disorders in which a person’s
behavior is affected by specific sleep stages or by the
transition between sleeping and waking. There are four
main categories of parasomnias:

1. Arousal disorders
occur when a person is in a state of partial
wakefulness. The person will act out a behavior, but
will not remember the activity when he is fully awake.
Examples include:

Sleepwalking — moving around the
house, or even outside, without being aware you are
doing it

Confusion arousal — crying and thrashing around
in bed, being confused and upset, and not wanting to be
awakened (common in infants)

Sleep terrors — screaming
and shouting, having a racing heart beat, sweating, and
being extremely agitated

Sleep eating — like
sleepwalking, but includes eating

2. Sleep-wake
transition disorders occur when a person is either in
the process of falling asleep or waking up. Examples
include:

Rhythmic-movement disorder
— banging the body
around, especially the head

Sleep starts — the body
jerks around; may be brought on by a sensation of
falling caused by a vivid dream

Nocturnal leg cramps —
Painful feelings in the legs or feet

Talking in one’s
sleep

3. REM associated disorders occur when a person is
in REM sleep (the period of deep sleep during which a
person dreams). Examples include:

Nightmares — bad
dreams that cause a person to wake up

Sleep paralysis —
not being able to move certain parts of the body during
sleep

What are the causes?Often, parasomnias have no explained cause, particularly
when they occur in children. Other times, they can be
caused by stress, lack of sleep, depression or certain
medications.

What are the signs and symptoms?A bed
partner can usually tell if a person is having episodes
of parasomnia behaviors. For instance, the bed partner
may observe the person talking in his sleep, awakening
due to nightmares, sleepwalking or having unusual body
movements during sleep.

In cases of severe parasomnia,
injury may occur when a person decides to act out a
dream or gets out of bed and moves around.

How is it
diagnosed?A specific parasomnia can be diagnosed after
a routine physical and discussion with a physician.

How is it treated?If a parasomnia behavior is present
in infants or children, it will probably pass in time.
In adults, medical treatment is often necessary. Many of
the behaviors can be treated with prescription drugs.
Others types of treatment include behavior therapy and
sleep reconditioning.

Certain precautions can be taken
to reduce the risk of injury caused by a parasomnia
behavior, such as:

●Clearing a path in areas where a
person often is found sleepwalking●Locking doors and
windows●Installing alarms on doors and windows

What is
it?Periodic limb movements disorder (PLMD) is a
disorder in which a person moves or kicks his legs
during sleep without an awareness of doing so. The
disorder is very similar to restless legs syndrome with
the exception that the kicks occur during sleep rather
than before sleep.

It is estimated about 5 percent of
the population may be affected by periodic limb
movements disorder by varying degrees. It is much more
common in older individuals over the age of 60.

What are
the causes?There are various causes.

●Many cases of PLMD
accompany other sleep disorders. Sleep apnea, narcolepsy
and insomnia can cause PLMD to occur.●Kidney disease can
cause PLMD.●The condition may be linked to a lack of
Vitamin E, iron and calcium in the body.●Antidepressants
tend to cause episodes of PLMD.

What are the signs and
symptoms?In addition to the jerking of the legs during
sleep, an individual may suffer from excessive daytime
sleepiness since the condition prevents a person from
getting a good night’s sleep.

How is it diagnosed?Diagnosis of periodic limb movements disorder is
primarily made based on results of a polysomnogram
(sleep study). Discussions with bed partners and a
medical history may indicate a study should be done. The
polysomnogram confirms the diagnosis.

How is it treated?The goal of treatment is to ensure that the involuntary
movements do not interrupt sleep patterns. Certain
medications may be prescribed to limit the movement.
Also, Vitamin E, iron and calcium supplements may be
prescribed if it is believed that deficiencies are
causing the problem.

There are some things an individual
with PLMD can do to help cope with the disease:

●Exercise
or keep active right before bed●Engage the brain in
activities to take the focus away from the urges and the
pain●Take a hot bath●Avoid caffeine and alcohol

What is
it?Restless legs syndrome (RLS) is a disorder in which
a person has a constant need to stretch or move the legs
to ease pain or discomfort. Many sufferers of the
disorder claim to feel creepy, crawly sensations in
their legs. These feelings tend to be stronger when an
individual is lying down or at rest, and they affect the
amount of sleep a person gets because of the thrashing.

It is estimated that 5-10 percent of the population may
be affected by restless legs syndrome by varying
degrees.

What are the causes?The absolute cause of
restless legs syndrome is unknown, but it is believed to
be a genetic disorder (hereditary). Research is being
done to determine which gene causes the behaviors
associated with restless legs syndrome. Caffeine
consumption and certain medications may be a factor in RLS. RLS may be the result of an underlying medical
condition, such as:

●Anemia and low levels of iron in the
blood●Kidney disease●Vitamin or mineral deficiencies●Poor blood circulation in the legs●Nerve problems●Muscle
disorders●Pregnancy (often occurring during the late
stages)

What are the signs and symptoms?Symptoms of
restless legs syndrome tend to worsen when the body is
relaxed, such as in the early evening or nighttime. They
will flare up as a person sits for a long period, such
as when on a plane, in a car, or when lying in bed.

An
individual with restless legs syndrome may have one or
both of these symptoms:

Uncontrollable urges to move
body parts — when a person has a sensation that he must
move body parts, such as the legs. This usually occurs
at night.

Pain in the legs — this sensation can range
from a shooting pain in the legs (usually in the
calves), to an uncomfortable feeling of constant
pressure on the leg. Other feelings can be burning,
itching, aching, tingling and cramping.

How is it
diagnosed?Diagnosis of restless legs syndrome is
primarily done through discussions with a physician. It
is likely that restless legs syndrome is an accurate
diagnosis if there is a family history of the condition.

Normally, a physical and neurological examination will
be done to identify other conditions that may be
associated with RLS. A polysomnogram (sleep study) at
Sleep Diagnostics / Sleep
Specialists may be suggested to determine if
other sleep problems are present.

How is it treated?Because the direct cause of restless legs syndrome in
unknown, only the symptoms of the disorder can be
treated. Symptoms often can be temporarily relieved by
stretching, moving or massaging the legs.

The goal of
treatment is to ensure that the involuntary movements do
not interrupt sleep patterns. Certain medications may be
prescribed to reduce the urges to move. Other
medications may be used to ease the pain felt in the
legs during periods of rest and relaxation.

There are
some things an individual with restless legs syndrome
can do to help cope with the disease:

●Exercise or keep
active right before bed●Engage the brain in activities
to take the focus away from the urges and the pain●Take
a hot bath●Avoid caffeine and alcohol

What is
it?Apnea means “without breath.” Sleep apnea is a sleep
disorder that results in interrupted sleep and is
characterized by loud snoring and instances of pauses in
breathing during sleep. These pauses in breathing occur
many times throughout the night and can last from 10
seconds to a minute or more.

Sleep apnea is very common,
as common as adult diabetes, and affects more than 12
million Americans. Yet, because of the lack of awareness
by the public and healthcare professionals, it often
remains undiagnosed and therefore untreated. It affects
people of all ages, but is seen more often in
individuals over the age of 40. It is found more often
in men – although more and more women are being treated
– and in overweight individuals.

What are the
causes?There are two types of sleep apnea — central
sleep apnea and obstructive sleep apnea.

Central sleep
apnea is less common and is caused by a failure in a
person’s nervous system. The muscles in the nervous
system do not receive the proper signals from the brain
to make breathing occur properly.

Obstructive sleep
apnea is caused by a blockage in the mouth or throat and
is far more common. A typical blockage may be a person’s
tongue, tonsils, or fatty muscle tissues in the throat.
Each time breathing is blocked, oxygen in the
bloodstream falls and the heart has to work harder to
circulate blood. When the brain senses the decrease of
oxygen, the sleeper is partially aroused just enough to
gasp for air.

What are the signs and symptoms?Someone
watching a person suffering from sleep apnea will
observe a pattern of loud snoring (which indicates the
airway is not fully open) interrupted by pauses in
breathing and gasps for breath during sleep.

How is it diagnosed?There are many types of sleep disorders that have the
same signs and symptoms. A polysomnogram (sleep study)
can determine if a patient has sleep apnea.

How is it
treated?The most common treatment of sleep apnea is
continuous positive airway pressure (CPAP). CPAP treats
obstructive sleep apnea by providing a gentle flow of
positive-pressure air through a mask to splint the
airway open during sleep. The result is that breathing
becomes regular, snoring stops, restful sleep is
restored, and quality of life is improved.

Other less
common treatments include surgery and oral appliances,
which may be effective in certain individuals. A
surgical procedure can be done to increase the size of
the airway by removing any obstruction such as enlarged
tonsils, polyps or growths that may be blocking it. An
unusually formed jaw may be causing the problem and can
be corrected with surgery.

Some patients may benefit
from an oral appliance that repositions the tongue or
jaw so that airflow is not restricted.

There are some
things people with sleep apnea can do to minimize the
effects of the disorder:

●Avoid alcohol and sleeping
pills●Lose weight (if overweight)●Sleep lying on one
side

What is
it?Snoring is the sound made when air passes through
the blocked or narrowed airway of a person who is
sleeping. Almost everyone snores occasionally. However,
frequent and loud snoring — especially if the person
snores, stops breathing for a few seconds, and then
starts again with a loud snort — can be a symptom of a
sleep disorder called sleep apnea.

What are the causes?During sleep, a person’s body naturally relaxes. The
tongue and lower jaw may drop back against the back of
the throat and partially block the airway. The body
reacts to this by trying harder to breathe; this
increased surge of air causes the soft tissues at the
back of the throat to vibrate, which creates the snoring
noise.

How is it diagnosed?People who snore heavily
should see a sleep specialist to find out if the snoring
could be causing episodes of sleep apnea. All snorers
have a partial block of the upper airway. But people
with sleep apnea have episodes of upper airway
obstruction where the airway is completely blocked for a
period of time, usually 10 seconds or longer.

Sleep
apnea can be diagnosed or ruled out with a polysomnogram
(sleep study). A polysomnogram of a person who snores
but does not have sleep apnea will show:

●Snoring and
other sounds occurring often and for long episodes
during sleep●No associated abrupt arousals, lowered
amount of oxygen in the blood, or cardiac disturbances●Normal sleep and respiratory patterns during sleep●No
signs of other sleep disorders

How is it treated?Doctors may recommend the following treatments for
people with severe snoring:

Change sleep positions —
rolling over to one side may help a person who only
snores when on his back. Some doctors recommend putting
a tennis ball in a sock, and pinning the sock to the
back of the person's pajama top.

Wear a dental appliance
to bed — some snorers may benefit from an oral appliance
that repositions the tongue or the jaw so that airflow
is not restricted.

Surgery — an outpatient procedure to
remove or reduce excessive and or obstructive tissue in
the back of the throat may be beneficial. Somnoplasty is
a procedure in which radio frequency waves are used to
remove excess tissue. In children, removing the tonsils
and adenoids is the most common type of surgery.

Behavioral and lifestyle changes — many, but not all,
cases of snoring are related to weight gain. Losing
weight can be a very effective form of snoring therapy.
Refraining from alcohol and sedatives also are often
recommended.